Understanding and Managing
High Blood Pressure
Check.
Change.
Control.
Check. Change. Control.
What is Blood Pressure?
When your heart pumps blood through the blood vessels, the blood pushes against the walls of
your blood vessels. This creates blood pressure. Your body needs blood pressure to move the
blood throughout your body, so every part of your body can get the oxygen it needs.
Healthy arteries (the blood vessels that carry oxygen-rich blood from the heart to the rest of the
body) are elastic. They can stretch to allow more blood to push through them. How much they
stretch depends on how hard the blood pushes against the artery walls.
For your arteries to stay healthy, it’s important that your blood pressure be within a healthy
range. Fortunately, there are things you can do to help keep your blood pressure in that range.
We’ll talk about that more later in this guide.
For some people, blood pressure can get too high. This is
true for about one-third of American adults (33.0%). This
can cause health problems that need to be dealt with
as you work with your healthcare provider. We’ll talk
about this, too, later in the guide.
Contents
What is Blood Pressure? . . . . . . . . . . . . . . . . 2
How Blood Pressure is Measured . . . . . . . . . 3
Know Your Risks . . . . . . . . . . . . . . . . . . . . . . . 5
Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Questions to Ask Your Doctor . . . . . . . . . . . 13
Managing High Blood Pressure . . . . . . . . . . 14
Arbor is a proud sponsor of the American Heart Association/
American Stroke Association’s High Blood Pressure Toolkit.
©2014 American Heart Association, Inc. All rights reserved.
This workbook is not intended as a substitute for professional medical care.
Only your doctor can diagnose and treat a medical problem.
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An interactive digital version
is available at
heart.org/HBPguide
How Blood Pressure is Measured
How can you tell what your blood pressure is? By using a
device called a blood pressure monitor, your healthcare
provider can measure your blood pressure to see if it’s
in a healthy range. You’ve probably had your blood
pressure taken during a visit to your healthcare
provider’s office.
Your blood pressure is recorded as two
numbers. The systolic blood pressure (the
“upper” number) tells how much pressure
blood is exerting against your artery walls
while the heart is pumping blood. The
diastolic blood pressure (the “lower” number)
tells how much pressure blood is exerting
against your artery walls while the heart is
resting between beats. Blood pressure is
measured in units of millimeters of mercury, or
mm Hg. For example, a blood pressure reading
might be 120/80 mm Hg.
A healthy blood pressure is under 120/80 mm Hg.
A blood pressure reading of 120-139 systolic
or 80-89 diastolic is defined as
“prehypertension.” This means that
the blood pressure is not high
enough to be called high blood
The table below shows healthy and unhealthy
pressure (hypertension),
blood pressure ranges as recognized by the
but that it is higher than
American Heart Association:
normal. If systolic blood
pressure is 140 or
Blood Pressure
Systolic
Diastolic
greater, or diastolic
Category
mm Hg (Upper #)
mm Hg (Lower #)
blood pressure is 90
or greater, it’s high
Normal
Less than 120
And
Less than 80
blood pressure.
Prehypertension
120-139
Or
80-89
High Blood Pressure
(Hypertension) Stage 1
140-159
Or
90-99
High Blood Pressure
(Hypertension) Stage 2
160 or higher
Or
100 or higher
Hypertensive Crisis
(Emergency care
needed)
Higher than 180
Or
Higher than 110
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Causes of high blood pressure
High blood pressure cannot be cured. It can, however, be managed very effectively
through lifestyle changes and, when needed, medication.
In most cases, the cause of high blood pressure is not known. In fact, high blood
pressure usually doesn’t have symptoms. This is why it is sometimes called “the
silent killer.”
However, there are known risk factors for high blood pressure. These are conditions
that are known to increase the risk for getting high blood pressure. Risk factors fall
into two categories: those you can control, and those that are out of your control.
Risk factors that are outside of your control
nnFamily history: Just as hair and eye color can run in families, so can high blood
pressure. If your parents or other close blood relatives have high blood pressure,
there’s an increased chance that you’ll get it, too. This is why it’s important to get
your blood pressure checked on a regular basis. The American Heart Association
recommends checking at your regular healthcare visit or every two years for people
whose blood pressure is in a normal range.
nnAge: The older you are, the more likely you are to get high blood pressure. As we age,
our blood pressures gradually lose some of the elastic quality, which increases blood
pressure.
nnGender: Until age 54, men are more likely to get high blood pressure than women
are. But that changes as we age. From age 55 to 64, men and women get high blood
pressure at similar rates. And at 65 and older, women are more likely to get high blood
pressure than men are.
nnRace: African Americans tend to develop high blood pressure more often than
Caucasians. For African Americans, high blood pressure also tends to occur at
younger ages and to be more severe.
Risk factors that you can control
nnLack of physical activity: Not getting enough physical activity as part of your
lifestyle increases your risk of getting high blood pressure. Physical activity is great for
your heart and circulatory system in general, and blood pressure is no exception.
nnAn unhealthy diet, especially one high in sodium. Good nutrition from a variety
of sources is critical for your health. A diet that is too high in salt consumption, as
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well as calories, saturated fat, and sugar,
carries an additional risk of high blood
pressure. On the other hand, making
healthy food choices can actually help
lower blood pressure.
nnOverweight and obesity: Carrying
too much weight puts an extra strain
on your heart and circulatory system,
and can cause serious health problems.
Being overweight increases your risk of
cardiovascular disease and diabetes. It
also increases your risk of getting high blood
pressure.
nnDrinking too much alcohol. Regular, heavy use
of alcohol can cause many health problems, including
heart failure, stroke, and irregular heartbeats. Drinking
too much alcohol can increase your risk of cancer, obesity,
alcoholism, suicide, and accidents. It can also cause your blood pressure to increase
dramatically.
In addition to these risk factors, there are others that may contribute to high blood
pressure, although how is still uncertain. These include:
nnSmoking and tobacco use: Using tobacco can cause your blood pressure to
temporarily increase and can contribute to damaged arteries, which can make high
blood pressure worse.
nnStress: Stress is not necessarily a bad thing in and of itself. But too much stress
may contribute to increased blood pressure. Also, too much stress can encourage
behaviors that increase blood pressure, such as poor diet, physical inactivity, and
using tobacco or drinking alcohol more than usual.
nnSleep apnea: This is a condition in which some of the tissues in the throat
collapse during sleep and block the breathing passageway. In response to that,
the brain awakens the sleeper, who then gulps for air in order to open the trachea
again. This cycle often repeats many times a night, leading to severe fatigue the
following day from a lack of good sleep. Sleep apnea can be a contributing factor
to high blood pressure.
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How high blood pressure affects
the body
Left untreated, high blood pressure can have damaging effects on your health. The
primary way it causes harm is by increasing the workload of the heart and arteries,
which causes damage to the circulatory system over time.
High blood pressure can cause the heart to enlarge because it has to work harder
to supply the blood the body needs. It also can contribute to a condition called
atherosclerosis, in which the walls of the arteries become stiff and brittle as fatty
deposits build up inside them.
Untreated high blood pressure can lead to coronary heart disease, heart failure, heart
attack, stroke, kidney damage, angina (chest pain related to heart disease), peripheral
artery disease, and other serious conditions.
In fact, people with high blood pressure over 140/90 are far more likely to have
these dangerous conditions. According to the American Heart Association, 77% of
Americans who’ve had a first stroke had high blood pressure at or over this level,
while the same is true of 69% of Americans who’ve had a first heart attack. And 74%
of Americans who have congestive heart failure have blood pressure levels above
140/90.
How high blood pressure is
diagnosed
While high blood pressure rarely has symptoms,
the good news is that it can be diagnosed using a
simple test with a blood pressure monitor. Your
healthcare provider will perform this test. The
most accurate type of monitor is called a bicep
cuff monitor. You’ve probably had this test
already, using this device.
To get your blood pressure reading, the cuff
is placed around your upper arm and inflated.
This temporarily stops the blood flow in the
arm. Your healthcare provider then slowly
deflates the cuff, observing the reading on
the monitor or listening through a stethoscope.
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As this happens, your healthcare provider takes note of your systolic and diastolic
pressure to determine your blood pressure reading.
Many things can affect blood pressure, so a diagnosis of high blood pressure is
usually made after two or more successive readings that exceed healthy blood
pressure ranges. Your healthcare provider will test you at least every two years if your
blood pressure readings are within healthy ranges, but more often if they’re not.
Monitoring, treating, and managing high
blood pressure
If you’ve been diagnosed with high blood pressure, it’s very important to follow the
treatment plan your healthcare provider gives you. This will almost certainly include
changes to your diet and level of physical activity, and may include medication, too.
Eating healthy
For people with high blood pressure (and those at risk
for it), a healthy diet is a must. There are many healthy
diet plans available, but the best for high blood
pressure include limiting sodium (salt) intake and
including a variety of nutritious foods. One proven
diet plan is called the DASH plan (DASH stands for
Dietary Approaches to Stop Hypertension).
The DASH plan emphasizes eating plenty of fruits
and vegetables, as well as low-fat protein sources
(such as skinless poultry, fish, and legumes), lowfat dairy products, and whole grains. It is also low in
sugars and red meat, and offers many other nutritional
benefits. You can learn more about the DASH plan by
visiting the website of the National Heart, Lung, and Blood
Institute: http://www.nhlbi.nih.gov/health/public/heart/hbp/
dash/new_dash.pdf.
As for sodium, you’ll want to limit your intake to no more than 1,500 mg per day,
which is associated with the greatest reduction in blood pressure. How can you tell
how much sodium you’re eating? By reading food labels. Be careful when you do
so—many foods that don’t seem to be salt-heavy may contain “hidden” sodium,
especially canned foods. Fortunately, food labels give an accurate picture of how
much you’ll ingest by eating that particular product.
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Physical activity
Physical activity is great for everyone. The health benefits of being active are many,
and among them are proven benefits to your heart and circulatory system. One of the
best ways to manage high blood pressure is to get plenty of physical activity.
Keep in mind that you don’t have to be an athlete to get the benefits of physical
activity. And you don’t even have to get all your daily activity in at one session. In
addition to traditional forms of exercise, healthy physical
activity can include:
nnParking farther away from your
destination to walk a bit more
nnTaking the stairs instead of the
elevator
nnTaking your dog out for a stroll
nnWalking instead of driving
To get the greatest benefits
from physical activity, the
American Heart Association
recommends:
nnAim for 3 to 4 40-minute
sessions per week of
moderate-to-vigorous intensity
physical activity
nnGetting at least 10 minutes of
physical activity per episode
It’s a good idea to check with your
healthcare provider before beginning a
physical activity program.
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Maintaining a healthy weight
Many Americans are overweight or obese, and
this is itself a risk factor for high blood pressure,
among many other serious health conditions.
If you are overweight or obese, your healthcare
provider can gauge how much weight you need
to lose by determining your body mass index (BMI).
BMI is determined by assigning a numerical value
to your weight in relation to your height. The American
Heart Association has a BMI calculator you can use here:
http://www.heart.org/HEARTORG/GettingHealthy/
WeightManagement/BodyMassIndex/Body-Mass-Index-InAdults-BMI-Calculator-for-Adults_UCM_307849_Article.jsp.
There’s good news here, too. Even losing 3% to 5% of your body weight can bring
good health benefits, such as reducing the workload on your heart. Talk with your
healthcare provider about the best way to lose weight. The safest way to lose weight
is typically to do so a few pounds at a time, by making changes to how many calories
you eat and how much physical activity you get. By reducing calories and increasing
your physical activity, you’re on your way to a healthier weight.
Reducing stress
Researchers continue to study how stress affects our health, and while we don’t
know exactly how stress impacts high blood pressure, we do know that it has an
effect. Stress makes us more likely to overeat or eat unhealthy foods, drink too much
alcohol, smoke (or smoke more than usual), and engage in other risky behaviors that
are known to have a bad effect on high blood pressure.
While stress is unavoidable, it can be managed effectively. There are some simple
things you can do to reduce the amount of stress you have to deal with. These
include:
nnGiving yourself time to get things done. Overscheduling yourself can increase
your stress load.
nnNot overpromising what you can do. There’s nothing wrong with saying “no” if
adding one more responsibility would be too much for you.
nnUnderstanding your stress triggers. Knowing what causes you to become
stressed and taking steps to avoid or manage (when you can’t avoid) those triggers
can help you control stress.
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nnPlanning to address what you can change, and accepting what you can’t
change. No one can do it all. Some things must be dealt with, and it’s good to have
a plan in place for doing just that. But some things are out of your control. Learn to let
those go.
nnTaking time to relax. There are countless ways to
relax, from breathing exercises to getting into a
hobby, from sitting in a favorite chair and listening
to soothing music to having a chat with a
cherished friend. Make sure you make time to
relax in a way that is good for you.
nnBuilding relationships with people
who care about you. We all need friends.
Having a support network helps you get
through tough times and enjoy good
times all the more.
nnTaking care of yourself. Eating healthy
and getting plenty of physical activity
has many benefits beyond your physical
health—it’s great for your emotional and
spiritual health, as well. Physical activity is a
great stress reducer.
Limit (or avoid) alcohol
Drinking too much alcohol raises your blood pressure and
is a risk factor for many other serious health conditions. If you do
drink alcohol, limit your drinking to no more than two drinks per day (for men) or one
drink per day (for women). A drink is one 12 oz. beer, 4 oz. of wine, 1.5 oz. of 80-proof
spirits, or 1 oz. of 100-proof spirits.
Avoid or quit tobacco
It’s simple: Tobacco is terrible for your health. It is a known risk factor for many
potentially deadly diseases, including cancer, heart disease, and lung disease, among
many other conditions. Smoking is the single most important preventable cause of
premature death in the U.S.
While the exact connection between tobacco and high blood pressure is unclear,
we do know that smoking causes blood pressure to temporarily rise. Smoking also
contributes to atherosclerosis, the hardening of and buildup of fatty deposits in the
arteries. Atherosclerosis can lead to serious conditions of the heart and blood vessels.
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If you don’t smoke, don’t start. If you do smoke, talk with your healthcare provider
about ways you can begin to quit. There are medications and programs available to
help you, and they have proved effective for many people.
Home blood pressure monitoring
One way to stay on top of how you’re doing in managing your high blood pressure
is to use a home blood pressure monitor. This can be a very important tool for you
and your healthcare provider to use in getting a “broader” picture of how well you’re
controlling your high blood pressure. Sometimes, a healthcare provider will even
recommend a home blood pressure monitor for people who are at risk for high blood
pressure but haven’t been diagnosed yet.
Choose a bicep monitor with an appropriately sized cuff, which will give the most
accurate readings. Make sure the monitor has been tested and validated. A list
of validated monitors is available here: http://www.dableducational.org/
sphygmomanometers/devices_2_sbpm.html#ArmTable.
Home monitoring can help eliminate false blood pressure readings, which happen
when temporary factors affect your blood pressure, and can help give a more reliable
picture of how your blood pressure is being managed to you and your healthcare
provider.
Medications
For many people, making changes to diet and lifestyle doesn’t do enough to lower
blood pressure to a healthy range. Fortunately, there are many medications that
can help. They each work in different ways to help lower your blood pressure. Not
all blood pressure medications work the same way for everyone, so you and your
healthcare provider may need to work together to try different medications until you
find the best one for you.
Other high blood pressure medications
nnDiuretics: Often the first medication tried with a person newly diagnosed high blood
pressure, diuretics work by removing excess salt and water from your body, which is
passed through urine. Diuretics are enough for some people, but others need more
help to lower blood pressure to a healthy range. In these cases, a healthcare provider
may prescribe an additional medication or a medication that contains a diuretic and
an additional medication. Diuretics can have side effects. These can include reduced
potassium in the body (which can be supplemented), increased blood sugar levels (a
potential problem for diabetics), and in some cases, flare-ups of gout or impotence.
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nnACE inhibitors: These medications work
by expanding blood vessels and reducing
resistance inside them. By doing this, ACE
inhibitors allow blood to flow more easily
and reduce the workload on the heart. Side
effects can include skin rash, loss of taste,
and a chronic, dry hacking cough. In rare
instances, kidney damage can result. ACE
inhibitors should not be taken by pregnant
women, and are not recommended for most
women of child-bearing age.
nnAngiotensin II receptor antagonists: These
medications stop a hormone called angiotensin II
from narrowing the blood vessels. These can cause
occasional dizziness. They should not be used in
pregnant women.
nnBeta blockers: These reduce the heart rate and decrease cardiac
output, which both help lower blood pressure. Side effects can include insomnia, cold
hands or feet, tiredness or depression, asthma symptoms, or a slow heartbeat. For
people with diabetes who take insulin, beta blockers have to be monitored carefully.
Women receiving beta blockers who are or may become pregnant should consult with
their healthcare providers to determine the safest treatment strategy.
nnCalcium channel blockers: These interrupt the movement of calcium into the heart
and blood vessel cells. These can cause palpitations, swollen ankles, constipation,
headache, and dizziness. Side effects can vary depending on the specific calcium
channel blocker prescribed.
nnCentral agonists: These work by limiting the ability of blood vessels to expand
and contract, thus lowering blood pressure. These can cause a rapid drop in blood
pressure while standing or moving, which can make you feel weak or faint. They can
also cause drowsiness or sluggishness, dry mouth, constipation, fever, or anemia.
nnPeripheral andrenergic inhibitors: These lower blood pressure by blocking the
chemical message the brain sends to the blood vessels to make them constrict.
These medications are typically only prescribed if other medications don’t help. Stuffy
nose, diarrhea, or heartburn can be side effects from this medication.
nnBlood vessel dilators: These cause the blood vessel walls to relax, which helps them
expand more easily and allow blood to flow more freely. These can cause headaches,
swelling around the eyes, heart palpitations, or aches and pains in the joints.
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Monitoring blood pressure medications
No matter what blood pressure medication you’re prescribed, you will need to work
with your healthcare provider to carefully monitor how well the medication is working.
It’s important to understand that taking blood pressure medication isn’t a short-term
fix. High blood pressure is a lifelong condition, so taking medication may be a lifelong
need. Do not stop taking your medication unless your healthcare provider tells you to
do so.
Your healthcare provider may want you to come in for office visits
frequently at first to check your blood pressure. Once your
blood pressure is under control, you will likely be tested
less often.
Another important purpose of careful monitoring
is to minimize the impact of side effects. If you’re
having side effects from the medications you’re
prescribed, talk with your doctor. A change in
dosage or in the type of medication you’re
taking may be appropriate. Your healthcare
provider will work with you to figure out the
best changes to make.
Take medications exactly as
prescribed
Your medications are designed to reduce your
blood pressure to a healthy range, but they can
only work if they’re taken exactly as prescribed.
This means following the dosage instructions on your
medicine bottle to the letter. If you are unsure about how
to take your medication, talk with your healthcare provider or
pharmacist.
Again, do not stop taking your medication unless you’re instructed to do so by your
healthcare provider.
If affording your medication is an issue, ask your healthcare provider if a generic
medication might be appropriate. These are as effective as name-brand medications
and are usually much cheaper. You may also want to look into getting help affording
your medications. Visit the Partnership for Prescription Assistance at www.pparx.org
or Needy Meds at www.needymeds.org to learn more.
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Living with high blood pressure
High blood pressure is a lifelong condition. Making healthy changes can help control
blood pressure, and you should consider eating healthy and getting more physical
activity to be lifelong habits.
The same is true of taking
medication. Dealing with side
effects can be a difficult matter,
but it’s worth working with your
healthcare provider to manage
side effects because taking
medication can make a huge
difference in how well you manage
your blood pressure. Controlling
your blood pressure means you’re
lowering your risk for heart disease,
heart attack, diabetes, stroke, and kidney
disease. Most people who control their
high blood pressure are able to live full,
healthy lives.
To keep your blood pressure under control,
follow these tips:
nnKeep your appointments with your
healthcare provider.
nnMake changes to your diet and physical
activity routines lifelong habits. Remember,
you don’t have to make dramatic changes
all at once. Make gradual changes that
you’re likely to keep pursuing.
nnFollow your healthcare provider’s advice,
including losing weight if recommended.
nnKeep your eyes on the prize: better health.
By reminding yourself of your goal, you are
putting yourself in a position to succeed.
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Keep Track of Your Heart Health
at Heart360!
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signing on at the American Heart Association’s website, www.heart360.org/cholesterol.
Here you can keep track of your cholesterol, blood pressure, physical activity, medications,
blood glucose, and weight—storing all your vital information in a Microsoft® HealthVault™
account. This easy-to-use tool puts you in control of your heart’s health. Sign up today!
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